That's oh-be-GUY-n, not oh-be-GIN, as some (primarily people from Texas) would like to refer to my chosen profession. Although, working in this field can sometimes cause one to develop a penchant for gin...hmmm.

Sunday, February 21, 2010

Ob/Gyns are *not* evil

Just because I'm an OB/GYN physician...

~ don't assume that I don't care about you as an individual.

~ don't assume that I'm out to cut your baby out of your womb in favor of getting home for dinner.

~ don't assume that I go home and roll around naked in piles of money.

~ don't assume that any inductions of labor that I schedule are done for *my* convenience.

~ don't assume that I will roll my eyes at your birth plan.

~ don't assume that my attempts to educate you about your pregnancy are "scare tactics."

~ don't assume that I am "what is wrong" with the way women give birth.

~ don't assume that the only way I know how to facilitate labor and delivery is through "unnecessary interventions."

~ don't assume that I am an unfeeling automaton who wants to "put you on the assembly line."

~ don't assume that I am "too busy" to take proper care of you.

~ don't blindly believe everything you see and read about my profession.

I've been doing some browsing through different labor/nursing/birth blogs, and, as it is wont to do, it depresses the living hell out of me. Partially because I know that I am not close to 90% of the descriptions I see from women out there, and partially because I'm starting to worry that maybe I am an exception and not the rule. In my current practice, I can see a definite split between the younger generation of physicians and the older generation. I certainly believe that through medical school and residency that I was taught a much more "collaborative" model of care than earlier generations. However, no one in my practice comes close to the urban legends out there perpetuated by the anti-medical world. I know I've ranted about this before, but it bothers me! So many physicians with whom I work have sacrificed *so much* for their training, for their ability to help people, just to be mistrusted and maligned by the population at large. Perhaps the most disheartening thing, is that there can be no real dialogue between the two philosophies, so jaded are our particular perspectives. Nothing I can say on this blog can convince you that I'm not a knife-wielding harpy, but if you were my patient, you would know.

P.S. I have been playing around, trying to start a facebook page for this blog. Any tips on how to make it better? I am poor at social networking!

50 comments:

Well, I just became your first fan. I loved this post. As an MD myself I often find that I have to defend our profession from those sorts of people all the time.

A friend just finished a stint where her newborn was in the NICU and half of the comments on her private posts about were - doctors/nurses are nasty and mean, don't let them bully you, you know best about your child, etc.

The fan page looks good so far. You might want to include links to things like: Mothers in Medicine, pages where people can get real information about Ob/Gyn services (other than the doctor hating, "busness of being born" websites).

I adore my OB. He was totally behind me when I wanted a c-section and totally behind me when I wanted a VBAC. When the VBAC failed, I had total faith that there was no element of taking the easy way out for him. I find some of the commentary about OBs sad as well. I've heard horror stories about midwives, too, but they never seem to get the same sort of rap. We seem to have a lot of trouble with middle ground in general and I do suspect we're in a time of transition in a lot of fields which can make it even trickier.

I live in a very liberal city (in the mid-west, actually) and have an OB who was completely on board with my low intervention birth plans and her whole practice let me have the birth I wanted (for #2; #1 was severe pre-e and HELLP so that didn't go the way anyone wanted).

But I know lots of women whose OBs are not this way and I've taken some flack for having an OB and not a midwife, even though my experience was perfect.

There's definitely an anti-OB bias out there and I do hope that future generations have the opportunity and ability to change it. A good friend is a (male) OB resident and often tells me "I channeled my inner midwife today."

I'm not a doctor, just a mom. I personally get annoyed at some of the things said about OB's so I can only imagine how it irks you. If it wasn't for a quick thinking OB, I probably would have died having my daughter (her elbow tore an artery and I lost over half my blood volume after delivery) and if it wasn't for another calm and cool OB, my son could have died or suffered irreversible brain damage during his birth. I owe my life and my child's life to my OB's. That is not a debt that can be repaid. I don't care that's it what they are "paid" to do, I cannot thank them enough. I'm expecting again and someone dared suggest a home birth to me because OB's "ruin childbirth". I am fairly certain my head spun around a few times. Childbirth is just one of those things that a great number of women romanticize and have huge expectations about how they want it to go. You can't make everyone happy but as long as mom and baby come out of it alive....well is there anything else that really matters more than that? Not to me.

I have to admit, my last OB has scarred my attitudes towards OBs in general. With this pregnancy, I am working with a different office that has midwives and OBs working together. I am going to be labeled with GD again, which makes me fear having to deal with the OBs in the new office. I am trying to keep an open mind, but sorry to say, I do think the bad apples make the rest of the bunch look very, very bad.

I am an obgyn and I love your post above! I find it frustrating to read the bashing comments people have of those in our specialty. When I was pregnant with my children, I read innumerable sites with such comments, and it was upsetting that people would have such perceptions of OBs. I work very hard to accommodate my patients birth plans, assist vaginal birth with manual rotations, alternate pushing positions and ambulation. I "love" my job, even when it keeps me from my own family for hours (or days!) at a time. I love it because it creates happy and healthy families, not because it allows me to operate, make money, or gives me social stature. Just like a wedding is a day, but a marriage is forever; people need to remember that child birth is just a moment in time, but that your child's health (and your own) is with you for a lifetime... Everyone needs to be flexible. I work to ensure a good outcome for both mom and baby, I do not think we should gamble with peoples lives.

Although our professions are totally different, I understand how you feel. At least docs are usually way higher on those popularity surverys than lawyers :) I feel so fortunate that I had a great OB and am sure your patients feel the same way about you.Amy in OH

I love your post. The reasons you listed are precisely the reasons that I do not go to baby showers. I am an obgyn. I cannot seem to brace myself for the onslaught of disappointments that every woman feels it is her god-given right to tell me! It hits me like a freight train every time!

I also find this attitude disheartening and I'm just a patient. I've read similar things on the internet (seeing as I've recently became fascinated with blogs of all types-but especially med blogs) and it really bothered me. I was induced for medical reasons and there were 5 doctors in the practice who all worked tirelessly to give me the vaginal birth I wanted. I never felt pressured at all. They were wonderful, based on your blog, I'm sure you're just as great to your patients as my doctors were to me.

It's frustrating when those who "serve the public" get such a bad rap.

I'm a teacher, my mom was a teacher, and the "teachers are so unqualified to do what they do" nonstop message both from average people and the media is so painful to hear when you are working so hard and with so little.

It's taken a little longer to stomp on doctors, but the healthcare system is as broken as education, and the players try their best and still, it can't be fixed by us alone. A few bad individuals get lots of press and we're all guilty by profession association. But people think it's justified to crucify teachers because test scores (tests which are flawed to begin with) are bad, and now the public thinks it's ok to skewer OBs because the C-section rates and complication rates are higher. It's easier to blame than to examine the root causes of the statistics in question and make any attempts to address any real problems in there.

Thank you for your blogpost. We wish that the world was filled with OBs just like you! Seriously! And, just like in every other profession, there are good and bad representatives of the OB/Gyn profession. But, when we are talking about birth, the memories of the care that a woman receives on the day she gives birth (both positive and negative) are engraved in her mind for life. How a woman births and the words and actions of those around her, really matter. And when her experience is negative, she shares that with others as she tries to make sense of what happened, what was said to her and how events unfolded and how she felt at the time, and later.

Doctors like you need to be copied and shared around the country and OBs that are hurtful, rude and disrespectful need to be removed from practice, no matter how excellent their technical knowledge is.

How women give birth really matters, and they deserve to be treated with respect.

Thank you deeply for doing just that with the families that you work with!

As a NICU nurse, I see mainly bad deliveries and unplanned outcomes, and I don't often see what's "normal." Things happen during birth that people can't control, including both mothers and OBs. I do get tired of hearing people complain - I'm all for natural if that's the way you want to go, but putting your baby at risk in the name of being "natural" is something I never want to be a part of.

I think you, as an OB, have an excellent balance of knowing when to do what (from what you've said on your blog, anyway), and you rejoice whenever you successfully end up with a high-risk vag delivery. You seem like a really, really excellent doctor - one who I would personally go to.

I've finally realized that the doctor-bashing just comes down to ignorance on the part of people who don't fully understand what can happen, and partly from a general mistrust of the medical field - but it still doesn't make it any less irritating.

Great post! I had an awesome OB for my pregnancy that worked with me every step of the way, I felt like we had a partnership in managing my pregnancy and birth. However, I found her because I switched from another OB who fit many of the stereotypes you list (she literally laughed when I said I wanted an un-medicated birth and got angry when I said I wanted a doula). I took my money elsewhere and have warned friends away from the "bad" OB practice to my "good" OB practice. I wonder if many of the worst complainers find it is easier to blame the OB then be honest about not educating themselves or shopping around for an OB (and hospital) that would support their wishes.

I'm a medical student pregnant with my first. After going to a couple of pregnancy & baby chat boards, I have absolutely ruled out OB/Gyn as a specialty. I do NOT want these women as patients.

They seriously do believe that OB/Gyns are the enemy, out to line their pockets and entertain themselves with harmful interventions, and NOTHING can change their minds. They know what they know, based on no evidence at all, and anybody who disagrees is part of the evil obstetrical-industrial conspiracy to deprive women of their right to a natural childbirth.

I should put up with constant accusations and hysteria, just to get sued for any outcome that's not perfect? No thanks.

I know all OBs aren't evil. And this is something that I really struggle with because I do think the system is broken. I'm pregnant with my 4th and recently witnessed my sister's 1st birth.

She agreed to an induction based on the fact that she was 40+5 and going insane. The OB agreed to start Pit and turn it off as soon as a good pattern was established. She labored until the wee hours of the morning until she hit a point where her contractions were one on top of e/o with no break. The L&D nurse walked in, talked to my sister mid-contractions, acted offended that she wasn't getting the responses she wanted, *turned the Pit up* and left. Shortly thereafter my sister tearfully requested an epidural consult. Again, same L&D nurse, assured her that she could push in any position she wanted, that they would work with her so she got the epi (and I'm glad she did!)

about 7 hours later the epi had worn completely off (my sister had full range of motion and sensation in her legs and everywhere else) and it was time to push! She was very worried about a pre-pregnancy hip degeneration issue so asked to change positions. The L&D nurse (new shift) said no - she'd had an epi so this was IT. Nurse then proceeded - after my sister specifically asked to not be coached while pushing - to coach *intensely* and tell my sister that this was the ONLY way that babies can come out.

The OB walked in to catch. That's all I saw of her so I have no clue how much of this was OB driven and how much was nurse driven (I actually see that it was nurse driven, but I know very little!)

Yes, all was good in the end. No one cut and episiotomy w/out permission (happened to my SIL) and no one died. But it was VERY frustrating for me to see things like the Pit being cranked, without discussion, when my sister was struggling with pain, and after they promised to start the Pit and then stop it. Or to hear them promise her they'd work with her to push comfortably and then not work with her when the time came (did they lie? did they change their mind?). In my mind the whole process saw my sister marginalized and dismissed. Having had a much more empowered (and yet safe) birth it was hard to watch her have to ask permission for every. little. thing and then be denied every. little. thing. Not one aspect of her experience *wasn't* managed. You'd really think, to quote the nurse, is that the only way babies come out is if the nurse makes it so.

I don't think this is a "fault" of an "evil" OB. I think my sister had the same experience I had w/ my 1st birth - the OBs promise everything up, down round and round and then when the day comes it's the L&D nurses who "manage" the birth and the doc comes in to catch. In that scenario it doesn't actually matter how good, kind, supportive of birth, whatever the OB is. The only thing that matters is the attitude of the nurse. Maybe OBs get a bad rap for what's really a nursing problem? Or maybe my sister and I saw the 2 OB groups on earth who don't actually see their own patients while they labor. Who knows.

As a patient this is something I REALLY struggle with. I don't want or need to have every aspect of my birth managed, thanks much, but I value the presence of medical expertise. So I may be one of those OB-bashers but it comes from a deep frustration regarding a system I see as immovable, inflexible and not at all friendly to my needs (autonomy, respect) as a birthing woman.

I was induced for persistently low fluids at 35 weeks. The high risk ob that I had been seeing throughout the pregnancy (I was on blood thinners due to a PE earlier in the pregnancy) would have preferred to give me a c-section so I wouldn't be off the blood thinners for too long. (How does that make any sense??) I felt like I had been strung along the entire pregnancy, because he had been telling me all along that they would work with my plan of having another drug free vaginal birth.

I'd had two previous home births, so I know what my body can do. Needless to say, I was not going to consent to a c-section for low fluids. Especially not after having been on the monitor and baby was looking great.

I'm grateful that I had a different on-call doctor for those 3 days who let me do things the way I needed them to be done. Had anything changed with baby and gone iffy, I wouldn't have argued a thing! But they didn't, and I had a great vaginal birth because of that wonderful man! (albeit with an epidural because 36 hours on pit - with no sleep- sucks).

In my area, we have quite a few OB's who have horrible reputations. From what I've seen at one hospital in particular they sure do have a lot of c-sections for fetal heartrate decels. A lot. It seems like the natural childbirth friendly ob's are hidden.

This post opened my eyes a bit. It must really hurt to have people assume these things about you.

Unfortunately, I've heard horror stories of doctors who seemed great, read birth plans and everything, and then did a 180 at 38 weeks, pushing for induction and every other intervention under the sun.

As a woman who plans to conceive in the near future, and who likes to educate herself on the topic of birth, I find myself feeling amazingly defensive. I feel like in our current system, I have no completely safe option.

I feel the need to shield myself from unnecessary intervention, but of course I also want access to quality medical care if something goes wrong. It's such a shame, both for me and for the caretakers who really do have my best interest at heart, that the actions of some have put me in the position of distrusting everyone.

You sound like a great OB...and truly, most of us natural birth advocates do know there are doctors like you. I can name a few of them in my community, and refer women to them.

We just feel frustrated that you seem to be few and far between. I seriously have seen women lied to, women forced to consent to procedures they did not want or need (really, is a vaginal exam really *needed* when the mom has only had 3 or 4 mild contractions since the last one was done 2 hours ago?), women yelled at for just asking questions.

One anonymous poster said:

Just like a wedding is a day, but a marriage is forever; people need to remember that child birth is just a moment in time, but that your child's health (and your own) is with you for a lifetime...

I'm sorry, but this poster just doesn't "get it." The "natural birth" movement pushes for low intervention birth because we know that a highly interventive birth can result in lifelong health complications. When the mom or baby are in distress of some sort--yes, interventions are needed. But when we watch inductions that are done for physician convenience, cesareans performed for "failure to progress" 12 hours into an induction with a first time mom who went from 0 to 9 cm during that 12 hours...can you really blame us for being angry?

Do any of these doctor bashing twits realize that just a few generations ago women DIED from "natural" at-home childbirth (the only kind going, back then) on a regular basis? Read the statistics from the early part of this century and then tell me how awful modern obstetrics are.

Can you say "child bed fever"? They were dying at home because that's where childbirth took place. They were also dying in the hospital too though not as much because it was a new thing. Hospital birth is a NEW idea! Improvement in women not dying in childbirth actually came about because of antibiotics and doctors learning to wash their hands between autopsies and vaginal exams not because of the place of birth or type of practitioner.

For the record, women STILL die in childbirth today, just as they did back then and so do babies. WE don't hear about it as much now because it is not widely advertised or reported as it should be. Our maternal mortality rate ranks us worse than most industrialized nations in the world... that's pretty sad for how many high-tech machines we have and use and how much money we spend on health care in our country. It isn't the OBs fault or the midwives, it's the system.

I recently learned that in a sample of "naturally-minded" women, only about 10% encountered the evil-OB sterotype. To me that was very encouraging and helped me overcome some of my biases against OBs in general. I also had the opportunity at one point to interview an OB during my pregnancy and found that I likely would have worked well with her, given how respectful she was.

Something, however, really does need to be done about that 10% of OBs who are causing so much emotional upset and high rates of interventions in women as they give birth. If 90% of OBs are providing the respectful care that mothers expect, then those 90% need to pressure the other 10% who are not as respectful into shaping up their game.

Marsden Wagner writes about the tribal politics of obstetrics, and if most OBs are giving appropriate care, then why isn't the tribe discouraging and having a greater impact on the poor performers? This is an honest question here, and I'd love to hear your thoughts.

I don't know how I happened on your blog, but as a chemist turned nursing student, I've learned to love it. I have an OB/GYN and I love him. He's never pressured me into anything, he's slow to cut, he doesn't pressure me into interventions, and he's consistently kind, which I cannot imagine is easy when you spend the bulk of your life dealing with hormonal women. Because he works in a shared OB patient practice, I've had the opportunity to see the partners in his practice too, and I find them all to be wonderfully kind and compassionate individuals. As someone who will work in a hospital and provide care with medical intervention in the near future, it upsets me that people are so rude and hateful towards doctors and nurses.

That being said, I think it's probably important to note that people generally get louder when they're slighted. This would imply that there's not a terribly large number of douche-bag MDs and L&D nurses roaming around, or that all midwives are perfectly kind, brilliant, and generally delightful practitioners. Rather, it's probably that the people who had poor experiences are much louder than those of us (and there are MANY, because I have many friends and the practice that I use for OB/GYN care is large and busy) who have had good experiences.

Sorry for the decidedly long comment. I'm putting off studying for an anatomy exam.

I hear you. You know, it took going through midwifery school for me to learn that the vast majority of the time OB docs and midwives are playing on the same team. We may come at things from different angles occasionally, but usually, when our paths intersect, it's for good reason. I learned that as a homebirth midwife, I cannot practice without the support and collaboration physicians in my community. In fact I moved to Washington state from a state where midwifery was until recently illegal for this very reason. I'm fortunate (and the women I care for) to enjoy pretty good relationships with the hospitals and docs in my region.I do see however that the locus of power here, sits firmly in your (the OB's) court. The systems are set up by and to serve the status quo, which is usually high volume, hospital obstetrics, hospital protocols and the greatest good for the greatest number. I don't see that changing radically anytime soon. In this country it's really hard for women desiring really personal, low-intervention, high- 'touch' care to get the care and births they want, and it becomes a very emotional and fraught experience if a prior birth inside the system was traumatic for them somehow (this was, admittedly my experience). Converts, as they say, are the worst! The pendulum sometimes quite understandably swings wildly in the other direction, into us versus them territory. As a midwife I now spend a LOT of time unpacking some of that with clients, preparing them well for transport eventualities so that they understand that if we wind up in the hospital during labor, or in physician care antenatally it's for good reason, because they need to be there.I can totally see how it would be upsetting to see all OB's tarred with those brushes. Similarly, it's very upsetting for homebirth midwives to be tarred with Dr. Amy's 'untrained, ignorant, dangerous crazy people' brush. I'm sure you're a great OB and your community is fortunate to have you.

I have had 2 babies - one hospital with interventions from the start and one birthing center natural birth. I plan on a home birth next. I believe that OB's are here for a reason, they have medical training and knowledge for women who are truly in need of their care and for that I am thankful. We also have midwives who are medically trained and knowledgeable of the natural process of birth. Each has a role and they are very different from one another. Instead of blaming OB's and Midwives for their 'evil' doings, why not take a look at our own selves and our own choices? We as birthing women have the choice - it is our body. Would you go to a foot doctor to have them look at your hand? No, so why would you go to an OB who is trained in high risk pregnancy for a normal birth? We as women need to educate ourselves and choose the right path for us and our babies and quit blaming others for our choices. 'Natural' childbirth is not something new and dangerous, it has been here since the beginning! Hospital births are new in the scheme of things - and still, maternal deaths are record high, even with all the technology!

(really, is a vaginal exam really *needed* when the mom has only had 3 or 4 mild contractions since the last one was done 2 hours ago?)

Well...if she's in labor..yes..I'd say it needs to be done.

I'm a medical student strongly considering going into OB/GYN for many, many reasons.

My main concerns are being male in what seems to be becoming a society in which many women are militant about seeing ONLY women for their OB/GYN needs and these folks that think they know more than people that have spent a decade or more specializing in women's health. Now, I'm not saying that these patients should not be HEARD or have a role in their care, but my experience has been that many that are part of this "movement" have no interest in listening to those trained on the issues...they just want to bash and state they know more than the docs...often without facts supporting them.

For the record, my interest in OB/GYN was piqued at the time we were studying womens health during 2nd year...at the same time my wife went through a miscarriage that was handled HORRIBLY (imo) by an OB/GYN. It was further piqued during my clinical rotation when i discovered I truly love learning about and practicing women's health. Not to mention Robotic Surgery. I like it all. I'm just worried about what the future would hold if that's the direction I go.

Thanks for this post. I dialogue a lot with folks that seem to paint us with a broad brush of badness that is hugely unjustified. As soon as we say a few decent things some of them post "oh you must be one of the good ones." There's a few comments like this on your post. The reality, which you realize, is that most OBs are pretty solid and deeply respect the wishes and desires of their patients.

You said >> Doctors like you need to be copied and shared around the country and OBs that are hurtful, rude and disrespectful need to be removed from practice, no matter how excellent their technical knowledge is.

When I read your site 90% of the comments I see are taken completely out of context, and do not mean what you and many of the readers think they mean. Readers often comment "can you believe that OB said that??", not understanding the real context of the comment. A lot of these comments make a lot of sense to me, as I often understand what context the comment was made in. It is telling that the person that posted the comment, as it probably means that the physician wasn't able to communicate what was going on in a way that the patient could understand. But they certainly don't mean what the majority of your readers think they mean.

You laud Dr Whoo here (which he deserves) but undeservedly attack OBs and other practitioners by encouraging random practitioner bashing on your site. In fact he may have made some of the comments on your site, as many of them are completely innocuous and many are quite appropriate. Some are bad, but they seem in the minority to me.

I've made some sharp comments from time to time, but I try to back off when it gets too hot. Your site seems to encourage a anti-OB attitude and hot comments, without giving any opportunity for the real meaning of these "quotes" to come out. Its a shame.

Whoever thinks maternal deaths are "at a record hight" hasn't a clue what went on in the early part of this century. Women died regularly from obstructed labor, hemorrage and eclampsia. The invention of the obstetrical forceps was acutally a lifesaving event for mothers and babies, as well as the gaining of the ability to do a safe ceasearean. Deaths from these causes are almost unheard of now.

Great post. I completely agree that many of the au natural types are over the top and down right hostile to the medical profession, I dont work in OB, But as a women who has had 3 difficult pregnancies in which my babies and I survived by medical interventions, I often feel quite alienated when I find my self in the presence of a women who feels that natural is the only way to go. I hate the term "overly medicalized pregnancy" it makes me bonkers. Women who feel this way and write these blogs and books are not only insulting the abilities of many OB's but they alienate all the women who have complications, as if we used a birthing ball it would make a difference when your pre-term, with right upper quadrant abdominal pain and an LDH of 1200...Thanks for helping me relize Im not the only person a little insulted and disapointed by this movement.

I don't comment much, but I am an out-of-hospital midwife. I always love your birth stories, and I always agree with your management. I know lots of OBs like you, and I know that there are many more good than bad-- just like with midwives.

Just the way many OBs only see the home births that aren't working, many midwives hear only the stories about OBs who didn't listen. We all have to have a level head and the sense to know that those stories are always the extremes and that most practitioners of all stripes have the same goal in mind: a healthy mom and a healthy baby.

When patients tell me their horror stories-- and let me tell, you, in general they are far from horrible, but are more "I didn't get what I wanted or I felt like I wasn't being listened to" stories IMHO-- I try so hard to remind them that no one in the hospitals is evil. Everyone is doing what they think is best and safest in the moment. Everyone has the best interests of the baby, fist and foremost, in mind. Mom's desires don't come first when the baby's needs are more urgent.

I would love it if you were practicing in my town. I would send you patients, because I like the way you practice and write and think. Your patients are lucky.

You can't please everyone, though. It would be nice if they didn't feel it was necessary to come to your office (or blog) to tell you that they think you suck, but some people just do love to do that.

I hope you felt better for writing this. you don't deserve the grief people give you when you are trying to do your job and keep their kid alive.

Wow. Where did you hear all that stuff? Personally, I have a FANTASTIC OB/GYN. I have been seeing him for about 7 years, and he delivered my son 4 years ago. Not only is he fantastic at what he does, but I bring him medical questions that don't even fall into his specialty because he is a genius and does not mind answering those questions for me. Aso, I trust him above and beyond all my other docs.

So take some relief in kno-wing that there are many women out there that think you guys rock!

See the blog that Micah referenced above. It's populated with a group of people I'm convinced are OB haters...and nothing will change their minds. I also wonder about the validity of some of the posts on there...and wonder if they are even remotely verified, or if it's a place for people to submit things in order to push an agenda.

I saw both a homebirth midwife and an OB for my last pregnancy. In the end, it was my OB who I think believed in my body's ability more than my midwife, and my OB who called me and left me her cell # when my baby was in the hospital for CHD repair. My midwife never called us to check on her once, despite all our "relationship building." I am very active in ICAN, but do find it unfair when practioners are painted with a certain brush just because of the letters behind their name. While I do think that there needs to be some sort of birth/health care reform in this country, I know there are many wonderful OBs who deserve to be respected for doing the absolute best job they can do!

After going through a twin pregnancy with my OB, I will be forever grateful for her. In regards to "cutting the baby out of the womb to get home in time for dinner" - I remember having a frank discussion with her about possibly having a C-section because of the risk of cord prolapse on Baby B. *I* brought up the subject of C-section out of my own fear. She assured me that if both babies were head down, the risk was very small and she would much rather (take the time to) deliver vaginally. Which I successfully did.

She listened to my concerns about as well as I ever could've imagined ANYONE doing. We had great discussions. She never dismissed a single thing I ever said. She cared about me as a patient AND me as a person. And she deeply cared about my unborn babies. I felt like she was completely invested in everything about me and my pregnancy. I wasn't just a number and certainly didn't get put on an assembly line.

Dr Whoo - I believe that you are a genuine, caring OB. This comes across in the manner in which you blog about your patients - 110%!!

Unfortunately, there are too many (in my opinion) OB/GYNs who are NOT like you. I can count on one hand how many physicians that I work with who I would choose as a care provider. That's rather sad, I think.

I am right there with AtYourCervix - I have worked with, and had (fired) numerous OBs who WEREN'T as awesome as you are. Just as there are bad doulas, bad midwives, bad patients... there are also bad OBs... and, unfortunately, in my experience, the more 'natural' their views, the more ostracized mamas are during their pregnancy/birth.

Again, I hate stereotypes, so I will never say ALL OBs, though. In fact, my OBs for my kids births were AWESOMELY supportive and genuine in their care.

PS, want to have a guest post on my blog? I would love to talk with you more about this. deelahthedoula(at)gmail.com

Totally agree. I LOVE my OB and trust her implicitly. I don't believe she is out to get home, hurry up, force me to do a C just to do one, etc. In fact, she said she would do everything possible to deliver my first on Xmas (didn't happen due to an emergency on her part). I was all "but it's Xmas and you have a family." She was all 'honey, I knew my schedule and life as an OB the day I went into med school. No worries."

My best friend, however, is an OB/GYN's nightmare. "Pitocin, C section, epidurals, etc. will hurt the baby. They're not necessary. It's for THEIR convenience."

Ugh she was 9 months of drama and a pain in the ass. When I visited her during her labor the look on the nurses faces--I felt bad for them.

Any OB that makes a patient feel the way you listed, should make that patient run. I admire everything your profession does and dont' know how you do it. I would be a weeping mess all the time.

I would like to express my gratitude to the OB who delivered my second and third babies many years ago, especially since at one point I became very angry with him at one point and have only recently understood where he was coming from.

This doctor made it possible for me to have a VBAC before that term had even been invented, in 1974. Since I was instructed to be in the hospital as soon as I knew I was in labor, he got a CNM to sit with me and monitor the baby every 15 minutes so I didn't have to be on EFM, which was just coming into use in those days; he believed having someone monitor every 15 minutes was just as good and had a study which showed that. When he finished his office hours he came in and sat with me for the entire rest of my labor. When my baby flipped posterior and my recti muscles split with a huge push (I had had a vertical incision externally) he delivered that baby with forceps with great skill and no harm at all to her. For my next baby he also protected me from the intern who wanted to put in an internal monitor, assured me when I said, no, I didn't need an epidural "unless I need it" that I wouldn't need it, and then was with me in the room for two hours of pushing. When I hear people's complaints about L&D nurses I realize that I hardly even saw one the first time and the second time only while I was being checked in. Hearing about your schedule I am amazed at the time my OB spent with me. So what made me so angry with him? (continued in next post)

When I started to feel the burning stretching sensation which showed that birth was near, I of course told him. I was squatting in the labor bed holding on to the rails so he couldn't see much. At that point I felt absolutely great, powerful, I was finally going to push out a baby. Now in those days it was normal to have a separate labor and delivery room, but I had asked him in the office, if I could deliver in the labor bed if I could push out the baby myself and he had said yes. But now he said we were going to the delivery room. I cried out " But you said I could deliver in the labor room!" and he said something so outrageous I couldn't understand how he could have said it "Well then its a good thing I lied to you." Before I knew it I was taken out of my squat and the bed was being pulled down the hall, the nurses were telling me to stop pushing, and I was pushing with all the strength of my fury. I found myself with my legs up in stirrups covered with blue drapes, my butt at the end of the table, just the way I had NOT wanted to have my baby! My doctor was at the door putting on gloves and I yelled at him Get the F over here and catch this baby before he falls on the F-ing floor!" In what seemed like a moment he was holding up my baby to show me and looking apologetic. He even said quietly "Next time you can stay home." (Yes, he actually did some home deliveries, but didn't come as far away as I lived.)Later when we talked about what happened he told me that he got concerned when he realized how large the baby was (he was 11 pounds) and told me that when he was in training, before he knew what to do, he had a baby whose shoulders got stuck who died. He said he also had a home birth with an 11 pound baby where the woman's bottom was sunk in a too soft bed and he couldn't get in there to do what he needed to do. They got her bottom up on some pillows and it was OK, but it was a scary situation for him, and he had felt he needed to be where he felt he could do what he needed to do. If only he had taken just a MOMENT to explain this to me he would have had a cooperative patient, not one who was cursing at him! I went on to ask him if he had had to do anything special and he said no, there was no problem. He even said at one point that "Size is no object for you obstetrically." I didn't ever have the guts to ask him why he said the awful thing he did,-I was afraid I would just choke up and cry and not be able to talk- and honestly it has taken me years to have some idea. He was really saying "Why would you think that I would lie to you, after the time I have spent with you, after I have taken so much flak from my colleagues for doing VBACs, for doing homebirths and supporting midwives, for not using EFM routinely, why is your first reaction to think I am doing this for no reason?" I think I am right that this is where this comment came from. But then I did not get it at all. At the best of times I am fairly dense, and perhaps when one's baby is close to crowning one can be excused for not grasping the emotional meaning under the actual words. Still, I am sorry that he felt that way, and sorry that I never did express gratitude as what he was willing to do really made an amazing difference in my life.

So here is a tribute to the late James D. Brew MD, a great OB!

This story does also go to show that everyone has to consider that laboring women are hypersensitive to the words of those around them, and that even very well intentioned doctors, nurses, and midwives, need to be careful in speaking to them.